Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

Current Workload Recommendations in Baseball Pitchers: A Systematic Review

BACKGROUND

Several recommendations have been made regarding pitch counts and workload for baseball players of different levels, including Little League, high school, collegiate, and professional baseball. However, little consensus is found in the literature regarding the scientific basis for many of these recommendations.

PURPOSE

The primary purpose of this study was to summarize the evidence regarding immediate and long-term musculoskeletal responses to increasing pitching workload in baseball pitchers of all levels. A secondary purpose of this review was to evaluate the extent to which workload influences injury and/or performance in baseball pitchers.

STUDY DESIGN

Systematic review.

METHODS

We performed a systematic search in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies addressing physiologic and/or pathologic musculoskeletal changes in response to a quantifiable pitching workload. We included studies examining the effects of pitching workload on performance, injury rate, and musculoskeletal changes in Little League, high school, collegiate, and professional baseball players.

RESULTS

We identified 28 studies that met our inclusion and exclusion criteria: 16 studies regarding Little League and high school pitchers and 12 studies regarding collegiate and professional pitchers. The current evidence presented suggests that increased pitching workload may be associated with an increased risk of pain, injury, and arm fatigue in Little League and high school pitchers. However, little consensus was found in the literature regarding the association between pitching workload and physiologic or pathologic changes in collegiate and professional pitchers.

CONCLUSION

Evidence, although limited, suggests the use of pitch counts to decrease injury rates and pain in Little League and high school baseball pitchers. However, further research must be performed to determine the appropriate number of pitches (or throws) for players of different ages. This systematic review reported conflicting evidence regarding the use of pitch counts in college and professional baseball. Future high-quality research is required to determine the role, if any, of pitch counts for collegiate and professional pitchers.

Advanced Baseball Metrics Indicate Significant Decline in MLB Pitcher Value After Tommy John Surgery

There are conflicting reports regarding the efficacy of Major League Baseball (MLB) pitchers following medial ulnar collateral ligament reconstruction (UCLR). As advanced baseball metrics have revolutionized the way general managers define pitchers' value, the authors believe that these should be used to measure clinical outcomes after UCLR. All MLB pitchers who underwent UCLR from April 1, 1991, through July 1, 2016, were compiled (N=253). Pitcher demographics and statistics were collected for up to 3 full seasons preceding and following surgery. Data for pitching controls (all MLB [AMLB] pitchers) were also collected (N=14,756). Prior to surgery, pitchers with UCLR were significantly better than the AMLB pitchers in nearly all advanced value-based statistics: higher wins above replacement (WAR; 0.93 vs 0.78; 95% confidence interval [CI], 0.80-1.06), lower fielding independent pitching (FIP; 4.23 vs 4.51; 95% CI, 4.12-4.34), lower expected fielding independent pitching (xFIP; 4.17 vs 4.38; 95% CI, 4.06-4.28), higher win probability added (WPA; 0.21 vs 0.05; 95% CI, 0.1-0.32), and higher leverage index (pLI; 1.03 vs 0.96; 95% CI, 0.99-1.06). Pitchers who returned to play after UCLR demonstrated significantly lower value with worse WAR, FIP, WPA, and pLI (P<.05). Conversely, after excluding pitchers who failed to achieve a sustained return to play of greater than 1 year, there were no significant decreases in value after surgery. The authors conclude that, prior to injury, pitchers who have UCLR are more valuable than average MLB pitchers. However, UCLR pitchers perform worse when compared with their presurgical values. This may be affected by players not being able to continue their careers for more than 1 year. [Orthopedics. 2019; 42(6):349-354.].

Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes

Background:

Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought.

Purpose:

To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016.

Study Design:

Case series; Level of evidence, 4.

Methods:

The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft).

Results:

A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time (R² = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft (P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique (P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs.

Conclusion:

Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.

Current Approaches to the Use of Artificial Intelligence for Injury Risk Assessment and Performance Prediction in Team Sports: a Systematic Review

Background

The application of artificial intelligence (AI) opens an interesting perspective for predicting injury risk and performance in team sports. A better understanding of the techniques of AI employed and of the sports that are using AI is clearly warranted. The purpose of this study is to identify which AI approaches have been applied to investigate sport performance and injury risk and to find out which AI techniques each sport has been using.

Methods

Systematic searches through the PubMed, Scopus, and Web of Science online databases were conducted for articles reporting AI techniques or methods applied to team sports athletes.

Results

Fifty-eight studies were included in the review with 11 AI techniques or methods being applied in 12 team sports. Pooled sample consisted of 6456 participants (97% male, 25 ± 8 years old; 3% female, 21 ± 10 years old) with 76% of them being professional athletes. The AI techniques or methods most frequently used were artificial neural networks, decision tree classifier, support vector machine, and Markov process with good performance metrics for all of them. Soccer, basketball, handball, and volleyball were the team sports with more applications of AI.

Conclusions

The results of this review suggest a prevalent application of AI methods in team sports based on the number of published studies. The current state of development in the area proposes a promising future with regard to AI use in team sports. Further evaluation research based on prospective methods is warranted to establish the predictive performance of specific AI techniques and methods.

Electronic supplementary material

The online version of this article (10.1186/s40798-019-0202-3) contains supplementary material, which is available to authorized users.

Influence of Pitching Release Location on Ulnar Collateral Ligament Reconstruction Risk Among Major League Baseball Pitchers

Background:

Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed among Major League Baseball (MLB) pitchers. The etiology of UCL injury is complex and is not entirely understood.

Hypothesis:

To better understand risk factors for requiring UCL reconstruction, we hypothesized that pitchers who eventually undergo the procedure will exhibit different throwing mechanics as measured by pitch-tracking data points, such as velocity and release location.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Pitch-tracking and demographic data were gathered for 140 MLB pitchers who had undergone UCL reconstruction between the 2010 and 2017 seasons. Pitch type, release location, and velocity were compared between the surgical cohort and a matched-control cohort.

Results:

When compared with controls, the mean pitch release location for pitchers who required UCL reconstruction was 12.2 cm more lateral in the year immediately preceding surgery (P = .001). Furthermore, within the surgical cohort, the horizontal release location was 3.4 cm more lateral immediately preceding surgery compared with 2 years earlier (P = .036). Binary logistic regression indicated an odds ratio of 0.51, suggesting a roughly 5% increased odds of UCL reconstruction for every 10 cm of increased lateral release location (P = .048). Both the surgical and the control cohorts threw similar rates of fastballs and had similar mean pitch velocity and fastball velocity. Control pitchers displayed a significant decrease over time in mean pitch velocity (P = .005) and mean fastball velocity, while pitchers in the UCL reconstruction cohort did not (P = .012).

Conclusion:

Pitch tracking indicates that the mean release point is more lateral in pitchers preceding UCL reconstruction as compared with controls, suggesting that a more lateral pitch release location is an independent risk factor for UCL injury and reconstruction.

Shoulder and Elbow Range of Motion Can Be Maintained in Major League Baseball Pitchers Over the Course of the Season, Regardless of Pitching Workload

Background:

Studies examining the evolution of shoulder and elbow range of motion (ROM) in baseball pitchers over a single season have yielded inconsistent results.

Purpose:

To evaluate shoulder and elbow ROM in Major League Baseball (MLB) pitchers over a single season and to assess for correlations between these changes and measures of a pitcher’s workload.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Bilateral shoulder ROM (internal rotation [IR], external rotation [ER], and total range of motion [TROM]) was assessed in 92 MLB pitchers pre- and postseason. Shoulder forward flexion (FF) was measured in 64 pitchers, horizontal adduction (HA) was measured in 87 pitchers, and elbow ROM was measured in 86 pitchers. Data collected included demographics (age, height, weight, and body mass index) and measures of workload for pitchers (pitches thrown, innings pitched, and mean fastball velocity). Pitchers were not specifically excluded if they had an injury during the season but had recovered and were actively pitching at the time of postseason measurements. The change in motion from pre- to postseason was measured and the associations with player demographics and workload were calculated by use of the Pearson correlation coefficient.

Results:

On average, pitchers demonstrated an increase in dominant shoulder ER from 118.8° to 125.4° (P < .001) and TROM from 173.1° to 181.7° (P < .001). HA was increased by an average of 15.7° (P < .001). The average shoulder IR (P = .189), FF (P = .432), and elbow ROM (flexion, P = .549; extension, P = .185) remained similar over the span of the season. Average glenohumeral IR deficit did not increase. Pitcher demographics and measures of throwing workload (total pitches thrown, innings pitched, mean fastball velocity) were not significantly correlated with changes in shoulder or elbow ROM.

Conclusion:

Significant increases in dominant shoulder ER, TROM, and HA were identified in MLB pitchers over the course of a single baseball season. These ROM changes were not correlated with measures of pitching workload.

Fastball Velocity and Elbow-Varus Torque in Professional Baseball Pitchers

CONTEXT

High loads in the elbow during baseball pitching can lead to serious injuries, including injuries to the ulnar collateral ligament. These injuries have substantial implications for individual pitchers and their teams, especially at the professional level of competition. With a trend toward increased ball velocity in professional baseball, controversy still exists regarding the strength of the relationship between ball velocity and elbow-varus torque.

OBJECTIVE

To examine the relationship between fastball velocity and elbow-varus torque in professional pitchers using between- and within-subjects statistical analyses.

DESIGN

Cross-sectional study.

SETTING

Motion-analysis laboratory.

PATIENTS OR OTHER PARTICIPANTS

Using the previously collected biomechanical data of 452 professional baseball pitchers, we performed a retrospective analysis of the 64 pitchers (52 right-hand dominant, 12 left-hand dominant; age = 21.8 ± 2.0 years, height = 1.90 ± 0.05 m, mass = 94.6 ± 7.8 kg) with fastball velocity distributions that enabled between- and within-subjects statistical analyses.

MAIN OUTCOME MEASURE(S)

We measured ball velocity using a radar gun and 3-dimensional motion data using a 12-camera automated motion-capture system sampling at 240 Hz. We calculated elbow-varus torque using inverse-dynamics techniques and then analyzed the relationship between ball velocity and elbow torque using both a simple linear regression model and a mixed linear model with random intercepts.

RESULTS

The between-subjects analyses displayed a weak positive association between ball velocity and elbow-varus torque (R² = 0.076, P = .03). The within-subjects analyses showed a considerably stronger positive association (R² = 0.957, P < .001).

CONCLUSIONS

When comparing 2 professional baseball pitchers, higher velocity may not necessarily indicate higher elbow-varus torque due to the confounding effects of pitcher-specific differences (eg, detailed anthropometrics and pitching mechanics). However, within an individual pitcher, higher ball velocity was strongly associated with higher elbow-varus torque.

Magnetic Resonance Imaging Findings of the Asymptomatic Elbow Predict Injuries and Surgery in Major League Baseball Pitchers

Background:

Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms.

Purpose:

To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery.

Results:

A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity (P = .021), humeral-sided partial UCL tears (P = .031), and PM impingement (P = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery (P = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage (P < .05 for all).

Conclusion:

UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.

Risk factors for ulnar collateral ligament injury in professional and amateur baseball players: a systematic review with meta-analysis

BACKGROUND

Risk factors for ulnar collateral ligament injury (UCLI) are unclear despite increasing injury rates. We sought to summarize UCLI risk factors in baseball players.

METHODS

A computer-assisted search of 4 databases was performed using keywords related to UCLI risk factors. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for study methodology. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes, and mean differences and 95% confidence intervals were calculated for continuous outcomes using a random-effects model.

RESULTS

Thirteen studies qualified for inclusion. A greater nondominant (ND) shoulder internal rotation (IR) range of motion (ROM) at 90° abduction arm demonstrated strong evidence as a significant risk factor for UCLI (P < .001) compared with a control group. Mean overall velocity (P < .001), fastball velocity (P < .001), changeup velocity (P = .03), and curveball velocity (P = .01), as well as fewer years of player experience (P < .001), less humeral retrotorsion in the ND arm (P < .001), and greater absolute side-to-side differences in retrotorsion (P = .006) were all moderate-evidence risk factors compared with control groups. Strong evidence suggests total ROM arc at 90° abduction in the dominant arm was not a risk factor for UCLI (P = .81).

CONCLUSIONS

Greater ND shoulder IR ROM and less humeral retrotorsion (in professional and amateur players) as well as pitching velocity (in professional players) demonstrated strong to moderate evidence as risk factors for UCLI. Dominant arm total arc of motion, external, or IR ROM were not risk factors for UCLI. Standardized collection and reporting of risk factors is recommended to more clearly elucidate definitive risk factors for UCLI.

Increased pitch velocity and workload are common risk factors for ulnar collateral ligament injury in baseball players: a systematic review

Importance

Ulnar collateral ligament (UCL) injuries commonly occur in baseball players. Strategies for injury prevention have long been accepted without clinical data informing which risk factors lead to serious injury.

Objective

The objective of this study was to systematically review the impact of various pitching-related risk factors for UCL injury in baseball players from all levels of play.

Evidence review

The electronic databases MEDLINE, EMBASE and PubMed were systematically searched until 4 March 2018, and pertinent data were abstracted by two independent reviewers. Search terms included ‘ulnar collateral ligament’, ‘medial ulnar collateral ligament’, ‘Tommy John’, ‘risk’ and ‘association’. Inclusion criteria were English-language studies, level of evidence I–IV and studies reporting risk factors for UCL injury of the elbow in baseball players. Study quality was assessed using the methodological index for non-randomised studies (MINORS) criteria. The results are presented in a narrative summary.

Findings

Pitching practices (workload and pitch characteristics) were reported in 9/15 studies. Specifically, three of four studies (n=1810) reported increased pitch workload as a risk factor for native UCL injury (p<0.001 to 0.02). The most common pitch characteristic reported was pitch velocity with four of five studies showing increased velocity being significantly associated with native UCL injury (p<0.01 to 0.02). Biomechanical risk factors reported were increased humeral retrotorsion (two studies; n=324), poor lower extremity and trunk balance (one study; n=42) and loss of total arc of shoulder motion (two studies; n=118), all significantly associated with UCL injury (p<0.0001 to 0.05). One of three studies assessing pitch workload as a risk factor for re-rupture of UCL reconstruction found a significant association (p<0.01).

Conclusions and relevance

Pitching practices, reflected by increased pitch workload and velocity, were most commonly associated with UCL injury; however, the definition of workload (number of pitches per game, inning or season) was inconsistently reported. Biomechanical risk factors were less commonly reported and lack sufficient evidence to recommend preventative strategies. More quality data is needed to refine the current recommendations for injury prevention in baseball players.

Level of evidence

III.

How many innings can we throw: does workload influence injury risk in Major League Baseball? An analysis of professional starting pitchers between 2010 and 2015

BACKGROUND

There has been increasing interest regarding the association between pitch counts, as well as total workload per season, and the risk of injury among Major League Baseball (MLB) starting pitchers.

METHODS

We used publicly available databases to identify all MLB starting pitchers eligible for play who made at least 5 starts in seasons between 2010 and 2015. For all included pitchers, annual pitching statistics (number of starts, total season pitch counts, total season inning counts, and average pitch count per game started) and annual disabled list (DL) information (time on DL for any reason and time on DL related to upper extremity, lower extremity, or axial body injury) were collected. A multiple logistic regression analyzed games started, pitch counts, innings pitched, and pitches per start during all previous seasons as a risk factor for injury in the current season, controlling for previous injury.

RESULTS

A total of 161 starting MLB pitchers met the inclusion criteria. With the exception of total innings pitched from 2010-2011 being significantly associated with DL placement in 2012 (no DL, 310.5 ± 97.5 innings; DL, 344.7 ± 85.9 innings; P = .040), no other finding for starts, pitch counts, innings, or pitches per start in the cumulative years from 2010-2014 had a significant association with pitcher placement on the DL for any musculoskeletal reason or for an upper extremity reason between 2011 and 2015.

CONCLUSIONS

In this study, we demonstrate that there is no association between preceding years of cumulative pitches, starts, innings pitched, or average pitches per start and being placed on the DL for any musculoskeletal reason.

Injury Prevention in Baseball: from Youth to the Pros

PURPOSE OF REVIEW

This review examines recent literature on injury epidemiology and prevention in the sport of baseball from youth to professional levels.

RECENT FINDINGS

Overuse is the predominant mechanism of injury in youth baseball players. Newer stretching and exercise protocols may help prevent these injuries. At the professional level, however, overuse has not been proven to correlate with increased injury incidence, but pitch counts are still monitored. There continues to be a rise in operations performed for baseball-related injuries, including ulnar collateral ligament (UCL) reconstruction, particularly in younger athletes. As the level of play increases, there is significant loss of participation due to injuries, such as the UCL in the upper extremity and the hamstrings in the lower extremity. Baseball is a widely popular sport, which has led to a focus on injury epidemiology and prevention. While the majority of research regarding baseball injuries focuses on pitchers, fielders and catchers are also at risk. In an attempt to decrease non-contact injuries in the upper and lower extremities, stretching and strengthening exercises are vitally important. Because injury profiles demonstrate significant variability from youth to professional baseball, unique prevention strategies are likely necessary at each level. More research is needed to develop and validate appropriately targeted injury prevention programs.

The Impact of Workload on the Evolution of Hip Internal and External Rotation in Professional Baseball Players Over the Course of the Season

Background

Although restricted hip range of motion (ROM) is associated with an increased risk for injuries in baseball players, the evolution of hip ROM over the season remains undefined.

Hypothesis

Hip ROM profiles would be symmetric between hips and positions (pitchers vs position players) but would decrease from preseason to postseason. Additionally, it was hypothesized that this decrease in motion would correlate with workload.

Study Design

Cohort study; Level of evidence, 2.

Methods

Bilateral hip ROM was assessed in 96 professional baseball players (54 pitchers, 42 position players) preseason and postseason. ROM comparisons were made between lead and trailing hips, pitchers and position players, and preseason and postseason measures. The change from preseason to postseason was correlated with player demographics and measures of workload for pitchers and position players.

Results

Preseason hip ROM was symmetric between hips; however, pitchers demonstrated increased preseason lead hip internal rotation (IR) (P = .018) and bilateral hip total ROM (TROM) (P < .020) compared with position players. From preseason to postseason, position players lost 7° of external rotation (ER) (P ≤ .005 ). In pitchers, the loss of IR correlated with increased pitches (P = .016) and innings (P = .037), while the loss of ER (P = .005 ) and TROM (P = .014) correlated with increasing mean fastball velocity. Workload for position players did not correlate with motion loss.

Conclusion

Symmetric hip ROM profiles should be anticipated in baseball players; however, pitchers may have increased preseason IR and TROM and postseason ER and TROM relative to position players. Although loss of motion correlated with workload in pitchers, this was not the case for position players. Hip motion should be monitored over the course of the season. This is particularly true for pitchers who lose IR as workload increases, which may place them at a greater risk for injuries.

Reasons for Retirement Following Ulnar Collateral Ligament Reconstruction Among Major League Baseball Pitchers

Background:

Ulnar collateral ligament reconstruction (UCLR) has become an increasingly common procedure among Major League Baseball (MLB) pitchers. The long-term effects of this procedure on the career of an MLB pitcher are largely unknown.

Purpose/Hypothesis:

The purpose of this study was to determine why and when MLB pitchers who underwent UCLR during their careers retired from baseball as compared with controls. We hypothesized that pitchers who underwent UCLR are no more likely than control pitchers to retire from elbow or shoulder problems.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

All MLB pitchers who underwent UCLR were identified through publicly available data. A cohort of pitchers who did not undergo UCLR were matched to pitchers with a history of UCLR, based on sex, age, draft year, and draft round. Of those who were no longer pitching in the MLB, the reason for retirement was determined. Reason for retirement and length of career following UCLR (surgical group) and index year (control group) were determined and compared through prior studies via the MLB HITS database, MLB team websites, and publicly available internet-based injury reports.

Results:

Overall, 153 MLB pitchers who underwent UCLR between 1974 and 2015 are currently retired. Mean ± SD time to retirement was 4.4 ± 4.7 years (range, 0-26 years) after the index year in the control group and 4.4 ± 3.5 years (range, 0-15 years) after surgery in the UCLR group (P = .388). Patients who were status post-UCLR were significantly more likely to be released during the season (34 of 144, 23.6%) than were players who were not status post-UCLR (14 of 144, 9.7%) (P = .002). Shoulder injury as a reason for retirement was more common in the control group than the UCLR group (P = .011). Elbow injury as a reason for retirement was not more common in either group (P = .379). Leg injury as a reason for retirement was more common in the control group (P = .013). Performance as a reason for retirement was more common in the UCLR group than the control group (P < .001).

Conclusion:

MLB pitchers who have undergone UCLR are no more likely to retire from shoulder or elbow injuries than are those who have not undergone UCLR. MLB career length was similar between pitchers with and without a history of UCLR.

The Effect of Regular-Season Rest on Playoff Performance Among Players in the National Basketball Association

BACKGROUND

There has been speculation that rest during the regular season for players in the National Basketball Association (NBA) improves player performance in the postseason.

PURPOSE

To determine whether there is a correlation between the amount of regular-season rest among NBA players and playoff performance and injury risk in the same season.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

The Basketball Reference and Pro Sports Transactions archives were searched from the 2005 to 2015 seasons. Data were collected on players who missed fewer than 5 regular-season games because of rest (group A) and 5 to 9 regular-season games because of rest (group B) during each season. Inclusion criteria consisted of players who played a minimum of 20 minutes per game and made the playoffs that season. Players were excluded if they missed ≥10 games because of rest or suspension or missed ≥20 games in a season for any reason. Matched pairs were formed between the groups based on the following criteria: position, mean age at the start of the season within 2 years, regular-season minutes per game within 5 minutes, same playoff seeding, and player efficiency rating (PER) within 2 points. The following data from the playoffs were collected and compared between matched pairs at each position (point guard, shooting guard, forward/center): points per game, assists per game, PER, true shooting percentage, blocks, steals, and number of playoff games missed because of injury.

RESULTS

A total of 811 players met the inclusion and exclusion criteria (group A: n = 744 players; group B: n = 67 players). Among all eligible players, 27 matched pairs were formed. Within these matched pairs, players in group B missed significantly more regular-season games because of rest than players in group A (6.0 games vs 1.3 games, respectively; P < .0001). There were no significant differences between the groups at any position in terms of points per game, assists per game, PER, true shooting percentage, blocks, steals, or number of playoff games missed because of injury.

CONCLUSION

Rest during the NBA regular season does not improve playoff performance or affect the injury risk during the playoffs in the same season.

Non-operative management of ulnar collateral ligament injuries in the throwing athlete

Medial ulnar collateral ligament (UCL) injuries have become increasingly prevalent in overhead athletes. The orthopaedic literature contains a wealth of information on operative management of these injuries. However, there are few high-quality longitudinal studies on non-operative care of UCL injuries. The purpose of this review is to describe the non-operative approach to managing UCL injuries, including recommended rehabilitation strategies and predictors of successful non-operative treatment.

Competitive bass anglers: a new concern in sports medicine

OBJECTIVE

Competitive bass angling involves sport fishing against other anglers while targeting a species of fish known as the black basses. Due to the rapidly growing popularity of high school competitive bass angling in Alabama and the nature of the casting motion similar to that of overhead athletes, we sought to examine the prevalence of sports type injuries in this population.

METHODS

In spring 2016, an anonymous survey was distributed across two large scale competitive high school fishing tournaments, allowing for a broad sampling of anglers throughout the state of Alabama. Survey items included demographic information, relevant past medical history, and various pains associated with the shoulder, elbow and wrist. Results were recorded and analyzed electronically using Microsoft Excel and IBM SPSS statistical software.

RESULTS

A total of 257 surveys were recorded. The response rate was 61%. The mean age of participating anglers was 15 ± 1.61 years. The majority (42%) of anglers fished year round. On average, anglers casted nearly 1,000 more times while competing versus fishing recreationally. Approximately 15% of anglers experienced shoulder, elbow, and wrist pain. The most common factors associated with pain included higher tournament cast counts, number of competitive years, number of tournaments/year, number of tournaments, and use of light weight lures.

CONCLUSION

A large portion of high school competitive anglers experience upper extremity pain. Knowledge of angling factors associated with pain allow for the creation of a modifiable routine to help reduce pain in affected anglers and prevent pain in healthy anglers.

Changes in pitching mechanics after ulnar collateral ligament reconstruction in major league baseball pitchers

BACKGROUND

Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball pitchers. Variations in pitching mechanics before and after UCL reconstructive surgery are not well understood.

METHODS

Publicly available pitch tracking data (PITCHf/x) were compared for all Major League Baseball pitchers who underwent UCL reconstruction between 2008 and 2013. Specific parameters analyzed were fastball percentage, release location, velocity, and movement of each pitch type. These data were compared before and after UCL reconstructive surgery and compared with a randomly selected control cohort.

RESULTS

There were no statistically significant changes in pitch selection or pitch accuracy after UCL reconstruction, nor was there a decrease in pitch velocity. The average pitch release location for 4-seam and 2-seam fastballs, curveballs, and changeups is more medial after UCL reconstruction (P < .01). Four-seam fastballs and sliders showed decreased horizontal breaking movement after surgery (P < .05), whereas curveballs showed increased downward breaking movement after surgery (P < .05).

CONCLUSIONS

Pitch selection, pitch velocity, and pitch accuracy do not significantly change after UCL reconstruction, nor do players who require UCL reconstruction have significantly different pitch selection, velocity, or accuracy than a randomly selected control cohort. Pitch release location is more medial after UCL reconstruction for all pitch types except sliders. Breaking movement of fastballs, sliders, and curveballs changes after UCL reconstruction.

The Effect of the Number of Carries Among College Running Backs on Future Injury Risk and Performance in the National Football League

Background:

There has been speculation that running backs with an excessive number of carries in college are less likely to be successful in the National Football League (NFL).

Purpose:

To determine whether there is a correlation between number of carries by college running backs and future performance and injury risk in the NFL.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Using the ESPN archives of National Collegiate Athletic Association and NFL running backs, the following inclusion criteria were used: running backs who played their last college season from 1999 through 2012 and who were drafted in the first 4 rounds of the NFL draft following their college career. Players were grouped by number of carries during their final college season (group A, 100-200 carries; group B, 250+ carries). Performance and injury risk were compared between groups during the first 3 eligible seasons in the NFL. Groups were compared based on total number of carries, mean yards per carry, number of games missed due to injury, and the specific injuries resulting in missed playing time.

Results:

During the seasons studied, a total of 103 running backs were included (group A, n = 42; group B, n = 61). There was a trend toward a significantly greater mean total number of carries through 3 NFL seasons in group B (group A, n = 276 carries; group B, n = 376 carries; P = .058). Mean yards per carry did not differ between groups (group A, n = 3.9 yards/carry; group B, n = 4.0 yards/carry; P = .67). Groups A and B missed a mean 5.8 and 5.7 games, respectively, due to injury during their first 3 NFL seasons (P = .98). A significantly greater proportion of players in group A suffered a concussion compared with group B (P = .014).

Conclusion:

There is no correlation between the number of carries by college running backs and future injury risk or performance during their early NFL career.

The Effect of the Number of Carries on Injury Risk and Subsequent Season's Performance Among Running Backs in the National Football League

Background:

In recent years, several studies have correlated pitch count with an increased risk for injury among baseball pitchers. However, no studies have attempted to draw a similar conclusion based on number of carries by running backs (RBs) in football.

Purpose:

To determine whether there is a correlation between number of carries by RBs in the National Football League (NFL) and risk of injury or worsened performance in the subsequent season.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The ESPN NFL statistics archives were searched from the 2004 through 2014 regular seasons. During each season, data were collected on RBs with 150 to 250 carries (group A) and 300+ carries (group B). The following data were collected for each player and compared between groups: number of carries and mean yards per carry during the regular season of interest and the subsequent season, number of games missed due to injury during the season of interest and the subsequent season, and the specific injuries resulting in missed playing time during the subsequent season. Matched-pair t tests were used to compare changes within each group from one season to the next in terms of number of carries, mean yards per carry, and games missed due to injury.

Results:

During the seasons studied, a total of 275 RBs were included (group A, 212; group B, 63). In group A, 140 RBs (66%) missed at least 1 game the subsequent season due to injury, compared with 31 RBs (49%) in group B (P = .016). In fact, players in group B missed significantly fewer games due to injury during the season of interest (P < .0001) as well as the subsequent season (P < .01). Mean yards per carry was not significantly different between groups in the preceding season (P = .073) or the subsequent season (P = .24).

Conclusion:

NFL RBs with a high number of carries are not placed at greater risk of injury or worsened performance during the subsequent season. These RBs may be generally less injury prone compared with other NFL RBs.